Influence of water on the microscopic dynamics of 1-butyl-3-methylimidazolium tetrafluoroborate studied by means of quasielastic neutron scattering

We present a systematic study on the effect of water on the microscopic dynamics of 1-butyl-3-methylimidazolium tetrafluoroborate by means of quasielastic neutron scattering. By mixing the ionic liquid with either heavy or light water, the different contributions to the quasielastic broadening could be identified and treated separately. This study was performed at room temperature, which is more than 15 °C above the demixing line. Our results show that even small amounts of water accelerate the diffusion mechanisms considerably. While samples with small water percentage reveal a diffusion process confined within ionic liquid nanodomains, an admixture of more than 15 wt. % water relieves the confinement. Furthermore, the presence of two water species was identified: one behaving as free water, whereas the other was interpreted as a component bound to the ionic liquid motion. Based on the fact that water preferentially binds to the BF4 anion, which itself has a negligible contribution to the scattered intensity, our experiments reveal unprecedented information about the microscopic anion dynamics.

Efficacy of Retreatment After Failed Direct-acting Antiviral Therapy in Patients With HCV Genotype 1-3 Infections

Hepatitis C virus infection is causing chronic liver disease, cirrhosis, and hepatocellular carcinoma. By combining direct-acting antivirals (DAAs), high sustained virologic response rates (SVRs) can be achieved. Resistance-associated substitutions (RASs) are commonly observed after DAA failure, and especially nonstructural protein 5A (NS5A) RASs may impact retreatment options.^1-3 Data on retreatment of DAA failure patients using first-generation DAAs are limited.^4-7 Recently, a second-generation protease- and NS5A-inhibitor plus sofosbuvir (voxilaprevir/velpatasvir/sofosbuvir [VOX/VEL/SOF]) was approved for retreatment after DAA failure.⁸ However, this and other second-generation regimens are not available in many resource-limited countries or are not reimbursed by regular insurance, and recommendations regarding the selection of retreatment regimens using first-generation DAAs are very important. This study aimed to analyze patients who were re-treated with first-generation DAAs after failure of a DAA combination therapy.

Protein-Polymer Dynamics as Affected by Polymer Coating and Interactions

We investigate the relaxation dynamics of protein-polymer conjugates by neutron scattering spectroscopy to understand to which extent the coating of a protein by a polymer can replace water in promoting thermal structural fluctuations. For this purpose, we compare the dynamics of protein-polymer mixtures to that of conjugates with a variable number of polymers covalently attached to the protein. Results show that the flexibility of the protein is larger in protein-polymer mixtures than in native protein or in conjugates, even in the dry state. Upon hydration, both the native protein and the conjugate show equivalent dynamics, suggesting that the polymer grafted on the protein surface adsorbs all water molecules.

Evidence of a one-dimensional thermodynamic phase diagram for simple glass-formers

Glass formers show motional processes over an extremely broad range of timescales, covering more than ten orders of magnitude, meaning that a full understanding of the glass transition needs to comprise this tremendous range in timescales. Here we report simultaneous dielectric and neutron spectroscopy investigations of three glass-forming liquids, probing in a single experiment the full range of dynamics. For two van der Waals liquids, we locate in the pressure-temperature phase diagram lines of identical dynamics of the molecules on both second and picosecond timescales. This confirms predictions of the isomorph theory and effectively reduces the phase diagram from two to one dimension. The implication is that dynamics on widely different timescales are governed by the same underlying mechanisms.

Changes in dynamics of α-chymotrypsin due to covalent inhibitors investigated by elastic incoherent neutron scattering

The dynamics of chymotrypsin increases when bound to two different covalent inhibitors. These effects were analyzed by univariate and multivariate methods.

Dielectric Susceptibility of Liquid Water: Microscopic Insights from Coherent and Incoherent Neutron Scattering

The analysis of neutron scattering results on H dynamics (H_{2}O) and the dynamic structure factor (D_{2}O) around the intermolecular peak and at intermediate length scales in terms of the susceptibilities reveals three processes (diffusive, local relaxational and vibrational) at frequencies below 3 THz, to which the contributions commonly invoked in dielectric studies can be directly mapped. We achieve a unified description of the results from both techniques, clarifying the nature of the molecular motions involved in the dielectric spectra and their impact on the structural relaxation.

Improving Pediatric Basic Life Support Performance Through Blended Learning With Web-Based Virtual Patients: Randomized Controlled Trial

BACKGROUND

E-learning and blended learning approaches gain more and more popularity in emergency medicine curricula. So far, little data is available on the impact of such approaches on procedural learning and skill acquisition and their comparison with traditional approaches.

OBJECTIVE

This study investigated the impact of a blended learning approach, including Web-based virtual patients (VPs) and standard pediatric basic life support (PBLS) training, on procedural knowledge, objective performance, and self-assessment.

METHODS

A total of 57 medical students were randomly assigned to an intervention group (n=30) and a control group (n=27). Both groups received paper handouts in preparation of simulation-based PBLS training. The intervention group additionally completed two Web-based VPs with embedded video clips. Measurements were taken at randomization (t0), after the preparation period (t1), and after hands-on training (t2). Clinical decision-making skills and procedural knowledge were assessed at t0 and t1. PBLS performance was scored regarding adherence to the correct algorithm, conformance to temporal demands, and the quality of procedural steps at t1 and t2. Participants' self-assessments were recorded in all three measurements.

RESULTS

Procedural knowledge of the intervention group was significantly superior to that of the control group at t1. At t2, the intervention group showed significantly better adherence to the algorithm and temporal demands, and better procedural quality of PBLS in objective measures than did the control group. These aspects differed between the groups even at t1 (after VPs, prior to practical training). Self-assessments differed significantly only at t1 in favor of the intervention group.

CONCLUSIONS

Training with VPs combined with hands-on training improves PBLS performance as judged by objective measures.

Dynamics of nanoscale polarization fluctuations in a uniaxial relaxor

We have studied neutron diffuse scattering in a Sr(0.61)Ba(0.39)Nb(2)O(6) single crystal by neutron backscattering at sub-μeV energy resolution. We can identify two response components with transverse polarization: an elastic (resolution limited) central peak, which monotonically increases with decreasing temperature, and a quasielastic central peak, having a maximum intensity around the ferroelectric phase transition close to 350 K. In contrast to previous neutron experiments on this and other relaxor materials, we were able to observe a temperature dependence of the characteristic frequency of these fluctuations, obeying the same Vogel-Fulcher law as the dynamic part of the dielectric permittivity of this material. In this way our findings provide a first direct link between the Vogel-Fulcher-type frequency dependence of dielectric permittivity and dynamic nanoscale lattice modulations with a transverse correlation length of about 5-10 unit cells.

Homocysteine metabolism in different human cells

The effects of cytokine and mitogen stimulation on homocysteine (HCY) metabolism in different cells were investigated: in human dermal microvascular endothelial cells (HDMEC), T lymphocytes, mature and immature dendritic cells, and myelomonocytic (THP-1) and monocytic cell lines (U-937). Furthermore, the influence of supplementation of cells with folate acid, methionine and the combination of both on HCY metabolism was investigated. Unstimulated HDMEC and dendritic cells only produced very little amounts of HCY, and stimulation did not change HCY formation significantly either. However, higher HCY concentrations were detected in HDMEC and dendritic cells under supplementation with methionine and slightly less under supplementation with folate. Proliferating T lymphocytes showed an increase in HCY production on stimulation with increasing doses of mitogens; proliferative activity was associated with HCY formation. THP-1 and U-937 cells produced significantly more HCY than endothelial cells; U-937 cells produced most HCY, which was mainly due to their high proliferation rate. Stimulation of both cell lines with lipopolysaccharide and interferon-γ, respectively, showed a significant effect on HCY production of cells; in THP-1 cells, stimulation with IFN-γ and lipopolysaccharide induced neopterin formation. Methionine supplementation strongly increased and folate supplementation slightly decreased HCY formation in both cell lines. Thus, inflammation may play a role in moderate hyperhomocysteinemia.

Follow-up of Urinary Neopterin Concentrations in two Healthy Children until Adolescence

Neopterin is a sensitive marker of the activated cellular (= Thl-type) immune response. Neopterin concentrations in healthy children are higher compared with those of adults and are declining with increasing age. In this study, we present a follow-up of urinary neopterin to creatinine concentrations in two healthy children until adolescence. Data were available from one female (7 - 23 years) and her brother (0 - 18 years), of whom early morning urine specimens were collected on an irregular basis throughout 18 years. In total, neopterin and creatinine concentrations were measured by high pressure liquid chromatography (HPLC) in 343 urinary specimens. In both children, concentrations of urinary neopterin were highest at study entry. With increasing age neopterin concentrations decreased continuously to reach rather constant levels around the age of fifteen years. On several occasions at which individuals presented with common sickness, mostly of infectious origin, neopterin concentrations were found highly increased. In the absence of such infectious episodes, neopterin/creatinine measurements of both individuals fit well to previously established normal ranges. However this was true only for specimens collcctcd when children were older than 10 years, before that age concentrations of neopterin were frequently found to be higher than the established upper limits of the normal range.

Homocysteine, Β Vitamins and Immune Activation in Coronary Heart Disease

Moderate hyperhomocysteinemia is associated with an increased risk of coronary heart disease (CHD). An inverse relationship usually exists between homocysteine and folate concentrations, and folate supplementation is often able to lower homocysteine concentrations. Thus, insufficient dietary intake of folate and/or vitamin B12 is considered to be responsible for the development of hyperhomocysteinemia. Inflammation and immune activation appear also to be important in the pathogenesis of CHD and may influence availability of folate. Blood concentrations of homocysteine, Β vitamins and neopterin were examined in 35 patients with CHD verified by coronary angiography, (2 1 patients with one-artery disease, 9 with two- or three-artery disease, 5 with restenosis). Compared to 30 healthy controls, a significant proportion of patients presented with increased homocysteine concentrations. Hyperhomocysteinemia coincided with lower folate and also with higher neopterin concentrations indicating immune system activation. In addition, correlations existed between neopterin and homocysteine (r = 0.472, ρ < 0.01) and folate (r = -0.370, ρ = 0.01). We conclude that higher homocysteine is not only associated with lower circulating folate but also with higher neopterin. Immune activation could be involved to cause an increased demand for folate resulting in hyperhomocysteinemia even when dietary folate intake is within the recommended range.

Neopterin and Oxidation Products in the Blood of Patients with Various Forms of Dementia

Human monocyte-derived macrophages and dendritic cells produce increased amounts of neopterin derivatives upon stimulation with interferon-γ (IFN-γ). In parallel, such stimulated cells release a record of oxidizing specics as part of their cytocidal repertoire. Production of reactive oxygen species by stimulated immunocompetent cells may be the reason for the depletion of antioxidant vitamins and the development of oxidative stress during diseases with stimulated immune system. Noteworthy also neopterin derivatives are able to interfere with reactive oxygen, chlorine, and nitrogen species, and neopterin itself could contribute to oxidative stress. In vivo, neopterin concentrations thus allow not only to monitor cell-mediated immune response, they also allow to estimate the extent of oxidative stress which emerges during immune response. In certain diseases associations between higher neopterin levels and markers of oxidative stress have been reported. In neurodegenerative diseases, neopterin concentrations in scrum and cerebrospinal fluid also correlate with the cognitive decline in patients. In this studv we compared serum concentrations of neopterin with serum concentrations of peroxides and homocysteine in patients with various forms of dementia and in 5 healthy elderly controls. In patients of either form of dementia serum concentrations of peroxides and neopterin were increased compared to controls. There existed a positive correlation between age and concentrations of peroxides, neopterin and homocysteine. The data further supportile view that increased neopterin concentrations are associated with oxidative stress which could underlie c¡r increased demand of antioxidants in neurodegenerative disorders. It appears important that such changes can h> detected in the blood of patients with dementia, albeit its pathogenesis is considered to be confined to the brain The results further suggest that aging is associated with immune system activation which may lead to the increased production of peroxides.

The non-Gaussian dynamics of glycerol

We have combined incoherent quasielastic neutron scattering experiments and atomistic molecular simulations to investigate the microscopic dynamics of glycerol moving away from the hydrodynamic limit. We relate changes in the momentum transfer (Q) dependence of the relaxation time to distinct changes of the single-particle dynamics. Going from small to large values of Q, a first crossover at about 0.5 Å(-1) is related to the coupling of the translational diffusion dynamics to the non-Debye structural relaxation, while the second crossover at a Q-value near the main diffraction peak is associated with the Gaussian to non-Gaussian crossover of the short-time molecular dynamics, related to the decaging processes. We offer an unprecedented extension of previous studies on polymeric systems towards the case of the typical low-molecular-weight glass-forming system glycerol.

Quasielastic neutron scattering study of hydrogen motions in an aqueous poly(vinyl methyl ether) solution

We present a quasielastic neutron scattering (QENS) investigation of the component dynamics in an aqueous Poly(vinyl methyl ether) (PVME) solution (30% water content in weight). In the glassy state, an important shift in the Boson peak of PVME is found upon hydration. At higher temperatures, the diffusive-like motions of the components take place with very different characteristic times, revealing a strong dynamic asymmetry that increases with decreasing T. For both components, we observe stretching of the scattering functions with respect to those in the bulk and non-Gaussian behavior in the whole momentum transfer range investigated. To explain these observations we invoke a distribution of mobilities for both components, probably originated from structural heterogeneities. The diffusive-like motion of PVME in solution takes place faster and apparently in a more continuous way than in bulk. We find that the T-dependence of the characteristic relaxation time of water changes at T ≲ 225 K, near the temperature where a crossover from a low temperature Arrhenius to a high temperature cooperative behavior has been observed by broadband dielectric spectroscopy (BDS) [S. Cerveny, J. Colmenero and A. Alegría, Macromolecules, 38, 7056 (2005)]. This observation might be a signature of the onset of confined dynamics of water due to the freezing of the PVME dynamics, that has been selectively followed by these QENS experiments. On the other hand, revisiting the BDS results on this system we could identify an additional "fast" process that can be attributed to water motions coupled with PVME local relaxations that could strongly affect the QENS results. Both kinds of interpretations, confinement effects due to the increasing dynamic asymmetry and influence of localized motions, could provide alternative scenarios to the invoked "strong-to-fragile" transition.

Investigation of the relationship between hydrogen bonds and macroscopic properties in hybrid core-shell gamma-Fe2O3-P(NIPAM-AAS) microgels

We investigate in a hybrid material the interactions existing between magnetic nanoparticles of gamma-Fe(2)O(3) and the polymer matrix constituted by core-shell poly(N-isopropylacrylamide-sodium acrylate) microgels. These interactions provoke the shifting of the microgel volume phase transition to higher temperatures when the amount of gamma-Fe(2)O(3) increases. The study was performed using different techniques such as incoherent quasi-elastic neutron scattering (IQNS), infrared spectroscopy (FTIR-ATR), and dynamic light scattering (DLS). Below the low critical solution temperature (LCST) of the polymer, the IQNS data confirm that the presence of inorganic nanoparticles affects the PNIPAM chain motions. Thus, in the swollen state both the mean-square displacement of the polymer segments and the diffusive motion of the polymer chains decrease as the iron oxide content increases. The FTIR-ATR study indicates that the reduction of vibrational and diffusional motions of the polymer chains is due to the formation of hydrogen bonds between the amide groups of the polymer matrix and the OH groups of the magnetic nanoparticles. The creation of this hybrid complex would explain the reduction of the swelling capacity with increasing the iron content in the microgels. Furthermore, this interaction could also explain the shift of the polymer LCST to higher temperatures as due to the extra energy required by the system to break the hydrogen bonds prior to the PNIPAM collapse.

Consequence of excess configurational entropy on fragility: the case of a polymer-oligomer blend

By taking advantage of the molecular weight dependence of the glass transition of polymers and their ability to form perfectly miscible blends, we propose a way to modify the fragility of a system, from fragile to strong, keeping the same glass properties, i.e., vibrational density of states, mean-square displacement, and local structure. Both slow and fast dynamics are investigated by calorimetry and neutron scattering in an athermal polystyrene-oligomer blend, and compared to those of a pure 17-mer polystyrene considered to be a reference, of the same Tg. Whereas the blend and the pure 17-mer have the same heat capacity in the glass and in the liquid, their fragilities differ strongly. Thus, the difference in fragility is related to an extra configurational entropy created by the mixing process and acting at a scale much larger than the interchain distance, without affecting the fast dynamics and the structure of the glass.

Interpenetrated PNIPAM-polythiophene microgels for nitro aromatic compound detection

In this work, we present a facile and reproducible method to obtain thermally responsive, monodisperse, fluorescent microgels with diameters smaller than 700 nm based on poly(N-isopropyl acrylamide) (PNIPAM) interpenetrated with poly(thiophene-ethyl buthyl sulfonate) (PTEBS). Changing the temperature and inducing the microgel volume phase transition, it is possible to modify the photoluminescence (PL) properties of the microgels. Thus, when the temperature was below the low critical solution temperature (LCST) of PNIPAM, the PL intensity was higher than that above the LCST. Time-resolved fluorescence measurements indicate that, in the swollen state, the increment of cross-linking increases the fluorescence decay time of PTEBS. By contrast, in the collapsed state, variations in the decay time were attributed to higher rigidity of the PNIPAM-PTEBS system, which was confirmed by neutron scattering measurements. Moreover, the shift in the wavelength of the fluorescence emission peak observed above the LCST indicates that the collapsed PNIPAM matrix was able to interact with the PTEBS chains hindering the formation of pi-pi interactions. This property is envisaged for developing a picric acid microsensor based on the formation of pi-pi interactions with the pi-conjugated polymer, thus quenching its PL emission. Above the LCST of PNIPAM-PTEBS microgels, the interactions would be broken and the initial PL emission would be recovered. This property could render reusable microsensors for detection of nitro aromatic compounds.

Direct evidence for the Nd magnetic ordering in NdMnO(3) from the hyperfine field splitting of Nd nuclear levels

We investigated the low energy excitations in NdMnO(3) in the µeV range by a backscattering neutron spectrometer. The energy spectra on polycrystalline NdMnO(3) samples revealed inelastic peaks at E = 2.15 ± 0.01 µeV at T = 2 K on both energy gain and energy loss sides. The inelastic peaks move gradually towards lower energy with increasing temperature and tend to merge with the elastic peak at the electronic magnetic ordering temperature of Nd, T(Nd)≈20 K. However, at temperatures higher than T(Nd)≈20 K the energy of the inelastic peak decreases at a much slower rate and remains finite up to T = 55 K, the highest temperature investigated. We interpret the inelastic peaks to be due to the transition between the hyperfine-split nuclear level of the (143)Nd and (145)Nd isotopes with spin I = 7/2 caused by the magnetic ordering of Nd electronic moment below T(Nd)≈20 K. We ascribe the finite energy of the inelastic peak and its much smaller temperature dependence at T>20 K to be due to the polarization of the Nd magnetic moment by the field of Mn moments that order below T(N)≈78 K.

Iron dynamics in Al-Cu-Fe quasicrystals and approximants: Mössbauer and neutron experiments

We present new results on the iron dynamics in the icosahedral quasicrystal i-AlCuFe and two cubic approximants as well as the non-approximant Al-Cu-Fe cubic B2 phase. Conventional Mössbauer spectroscopy is used as well as, for the i-AlCuFe phase, high Doppler velocity Mössbauer spectroscopy and quasielastic neutron scattering for samples with different Fe isotope contents. We show that in the i-phase the Fe Lamb-Mössbauer recoilless fraction decreases below that predicted for lattice vibrations alone for temperatures above about 550 K. This decrease is correlated with the onset of a quasielastic signal seen in both Mössbauer and neutron backscattering spectroscopy, which indicates the presence above 550 K of Fe jump processes confined in a local cage. The timescale of the Fe jumps (660 ps at 1000 K) and their temperature dependence differ widely from those of Cu jumps in the same i-AlCuFe quasicrystal. From the temperature dependence of the quadrupole splitting of the (57)Fe Mössbauer spectrum, one can distinguish two kinds of Fe jumps, one starting at 550 K and the second above 800 K. In the two cubic approximants, a loss in the Fe recoilless fraction also occurs above 550 K, revealing the same kind of Fe dynamics as in the i-phase but the effect is smaller. On the other hand, no anomalous Fe dynamics (other than lattice vibrations) is detected in the B2-AlCuFe phase. Since the cubic approximants possess similar local configurations as the quasicrystal, we conclude that locally a Penrose tile description is appropriate. This shows that the detected Fe jumps can be interpreted in terms of phason-like local tiling flips.

New sources and instrumentation for neutrons in biology

Neutron radiation offers significant advantages for the study of biological molecular structure and dynamics. A broad and significant effort towards instrumental and methodological development to facilitate biology experiments at neutron sources worldwide is reviewed.

Influence of pressure on the boson peak: stronger than elastic medium transformation

We study the changes in the low-frequency vibrational dynamics of poly(isobutylene) under pressure up to 1.4 GPa, corresponding to a density change of 20%. Combining inelastic neutron, x-ray, and Brillouin light scattering, we analyze the variations in the boson peak, transverse and longitudinal sound velocities, and the Debye level under pressure. We find that the boson peak variation under pressure cannot be explained by the elastic continuum transformation only. Surprisingly, the shape of the boson peak remains unchanged even at such high compression.

Molecular dynamics of a short-range ordered smectic phase nanoconfined in porous silicon

4-n-octyl-4-cyanobiphenyl has been recently shown to display an unusual sequence of phases when confined into porous silicon (PSi). The gradual increase of oriented short-range smectic (SRS) correlations in place of a phase transition has been interpreted as a consequence of the anisotropic quenched disorder induced by confinement in PSi. Combining two quasielastic neutron scattering experiments with complementary energy resolutions, the authors present the first investigation of the individual molecular dynamics of this system. A large reduction of the molecular dynamics is observed in the confined liquid phase, as a direct consequence of the boundary conditions imposed by the confinement. Temperature fixed window scans reveal a continuous glasslike reduction of the molecular dynamics of the confined liquid and SRS phases on cooling down to 250 K, where a solidlike behavior is finally reached by a two-step crystallization process.

Hyperhomocysteinaemia and immune activation in patients with cancer

BACKGROUND

Recently, homocysteine production was observed in tumour cell lines and homocysteine was proposed as a tumour marker. Furthermore, homocysteine production by activated immunocompetent cells was demonstrated.

METHODS

In this study, homocysteine metabolism and immune activation status were investigated in 128 patients suffering from various types of cancer (haematological disorders, lung cancer, gastrointestinal tumours, gynaecological cancer and tumours of other localisation) and healthy age-matched controls.

RESULTS

A high percentage of patients (39.1%) showed moderate hyperhomocysteinaemia, while cysteine, folate and vitamin B(12) concentrations were within reference ranges. Most patients were found to have elevated concentrations of the immune activation and inflammation markers neopterin and C-reactive protein (CRP), as well as a higher erythrocyte sedimentation rate (ESR). Patients of different cancer groups differed significantly regarding vitamin B(12) and neopterin concentrations; higher B(12) levels were also associated with tumour progression. Univariate regression analysis showed that CRP, ESR and neopterin were suited best to predict death. In multivariate analysis, neopterin was best suited to predicting death, while homocysteine and B vitamins were not associated with patient outcome. Homocysteine concentrations were correlated with folate and cysteine levels. Higher neopterin concentrations coincided with lower folate concentrations, but higher vitamin B(12) concentrations.

CONCLUSIONS

Associations between neopterin and folate concentrations may indicate that cellular immune activation might partly contribute to the development of folate deficiency in cancer patients, thus possibly also impairing homocysteine remethylation.

Food preservatives sodium sulfite and sorbic acid suppress mitogen-stimulated peripheral blood mononuclear cells

Antioxidant preservatives prolong the quality of food and ensure the nutritional adequacy, palatability and safety of many processed foods and beverages. Effects of sodium sulfite (E221) and sorbic acid (E200) were investigated in human peripheral blood mononuclear cells (PBMC) which were purified from blood of healthy donors. Cells were stimulated with the mitogen phytohaemagglutinin in vitro, which induces proliferation of T-cells and the production of Th1-type cytokines like interferon-gamma. The latter triggers enzyme indoleamine (2,3)-dioxygenase, which degrades tryptophan, and GTP cyclohydrolase I, which leads to increased neopterin production, in monocyte-derived macrophages. Sodium sulfite and sorbic acid suppressed both these biochemical changes in a dose-dependent way (P<0.01 at 1 mM sodium sulfite and 50 mM sorbic acid). Data demonstrate a suppressive influence of sodium sulfite and sorbic acid on the activated Th1-type immune response.

Homocysteine but not neopterin declines in demented patients on B vitamins

Inflammation and immune system activation seem to play an important role in the development and progression of dementia. Hyperhomocysteinemia is common in various forms of dementia, and a significant relationship was found between concentrations of homocysteine and immune activation marker neopterin. B vitamin supplementation is able to slow-down homocysteine formation in patients. In an open-label study, effects of B vitamin supplementation (Beneuran compositum ) on concentrations of homocysteine and neopterin were investigated in 58 patients with Alzheimer's disease (n=30), vascular dementia (n=12) and mild cognitive impairment (n=16). In all groups of patients, a significant percentage of patients presented with homocysteine concentrations >15 micromol/L and with elevated concentrations of immune activation marker neopterin. Decline of homocysteine concentrations was observed after one month of B vitamin supplementation (all p<0.01; paired Kruskal-Wallisn-test). By contrast, neopterin concentrations remained unchanged (all p>0.05). B vitamin supplementation in patients with various forms of dementia did not influence neopterin concentrations, which indicates that the degree of immune activation and inflammation remained unchanged. The question remains, if lowering of homocysteine by folate supplementation alone could have any beneficial effect to modulate the course of dementia development and if longer period of supplementation would also ameliorate immune system activation status.

Crucial role of interferon-gamma and stimulated macrophages in cardiovascular disease

Inflammation and immune activation are crucially involved in the pathogenesis of atherosclerosis and cardiovascular disease. Accordingly, markers of inflammation such as fibrinogen, ferritin, C-reactive protein or neopterin are found in patients with vascular diseases, correlating strongly with the extent of disease and predicting disease progression. Neopterin formation by human monocyte-derived macrophages and dendritic cells is induced by the pro-inflammatory cytokine interferon-gamma, which is released by activated T-lymphocytes. Human macrophages are centrally involved in plaque formation, and interferon-gamma and macrophages are also of importance in the development of oxidative stress for antimicrobial and antitumoural defence within the cell-mediated immune response. Interferon-gamma also stimulates the enzyme indoleamine-2,3-dioxygenase, which degrades tryptophan to kynurenine. Again, macrophages are the most important cell type executing this enzyme reaction, but also other cells like dendritic cells, endothelial cells or fibroblasts can contribute to the depletion of tryptophan. Likewise, enhanced tryptophan degradation was reported in patients with coronary heart disease and was found to correlate with enhanced neopterin formation. In chronic diseases such as in cardiovascular disease, biochemical reactions induced by interferon-gamma may have detrimental consequences for host cells. In concert with other pro-inflammatory cytokines, interferon-gamma is the most important trigger for the formation and release of reactive oxygen species (ROS). Chronic ROS-production leads to the depletion of antioxidants like vitamin C and E and glutathione, with a consequence that oxidative stress develop. Oxidative stress plays a major role in the atherogenesis and progression of cardiovascular disease, and it may also account for the irreversible oxidation of other oxidation-sensitive substances like B-vitamins (e.g. folic acid and B12). They are essential cofactors in homocysteine-methionine metabolism. Associations between moderate hyperhomocysteinaemia and cellular immune activation are found in several diseases including coronary heart disease, and data indicate that hyperhomocysteinaemia may develop as a consequence of immune activation. Homocysteine accumulation in the blood is established as an independent risk factor for cardiovascular disease. Homocysteine itself has the capacity to further enhance oxidative stress. Interferon-gamma appears to be a central player in atherogenesis and in the development and progression of cardiovascular disease. Anti-inflammatory and immunosuppressive treatment (e.g. with non-steroidal anti-inflammatory drugs or statins) may among other consequences, also contribute to a slow-down of the adverse effects of interferon-gamma.

ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology

Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility of increasing or ensuring nutrient intake in cases where normal food intake is inadequate. These guidelines are intended to give evidence-based recommendations for the use of ONS and TF in cancer patients. They were developed by an interdisciplinary expert group in accordance with officially accepted standards, are based on all relevant publications since 1985 and were discussed and accepted in a consensus conference. Undernutrition and cachexia occur frequently in cancer patients and are indicators of poor prognosis. EN should be started if undernutrition already exists or if food intake is markedly reduced for more than 7-10 days. Standard formulae are recommended for EN. Nutritional needs generally are comparable to non-cancer subjects. In cachectic patients metabolic modulators such as progestins, steroids and possibly eicosapentaenoic acid may help to improve nutritional status. EN is indicated preoperatively for 5-7 days in cancer patients undergoing major abdominal surgery. During radiotherapy of head/neck and gastrointestinal regions dietary counselling and ONS prevent weight loss and interruption of radiotherapy. Routine EN is not indicated during (high-dose) chemotherapy.

[Effectiveness of antiviral therapy in patients with chronic hepatitis C treated by private practice gastroenterologists]

The standard treatment for patients with chronic hepatitis C consists of pegylated interferon (PegIFN) alpha in combination with ribavirin. Information on treatment effectiveness outside clinical trials is sparse. To study community-based health care, a regional network supported by the German network of competence for hepatitis (Hep-Net) was created between gastroenterologists in private practice and a tertiary referral centre. A treatment register containing evidence-based guidelines was established and 212 consecutive patients who were treated with either PegIF Nalpha 2a/ribavirin (n = 126) or PegIFNalpha2b/ribavirin (n = 86) for 24 weeks (HCV genotype 2, 3) and 48 weeks (HCV genotype 1, 4, 5), respectively, were included and followed prospectively. Twenty-four weeks after cessation of antiviral treatment a sustained virological response was achieved in 54 % of the patients. By univariate analyses, infection with HCV genotypes 2 or 3 (p < 0.0001), younger age (p < 0.0001), normal gamma-glutamyltransferase levels before initiation of treatment (p = 0.003), and absence of language communication problems (p = 0.023) were associated with a sustained virological response. The presence of liver cirrhosis in patients with HCV genotype 1, 4, 5 infection was associated with lower sustained response rates (p = 0.025). Patients infected with HCV genotype 1 in whom the PegIFNalpha dose was reduced had higher virological relapse rates (p = 0.049). With regard to the treating physician, sustained virological response rates ranged from 26 - 67 % in patients infected with HCV genotype 1. Our study shows that virological response rates similar to those in international randomised clinical trials can be achieved by private practice gastroenterologists. The presented network allows characterization of the treatment outcome in chronic hepatitis C not only with regard to virus- and host-related factors but also on an individual physician basis.

Atorvastatin suppresses homocysteine formation in stimulated human peripheral blood mononuclear cells

Hyperhomocysteinemia is regarded as an independent risk factor for vascular diseases, and homocysteine is supposed to contribute to oxidative stress and endothelial damage. Statin therapy is an established intervention to reduce the risk of acute events in patients suffering from cardiovascular diseases. Apart from their lipid-lowering capacity, statins also exert anti-inflammatory and antioxidant effects. As cellular immune activation and oxidative stress play a major role in the pathogenesis of cardiovascular diseases, the anti-inflammatory capacity of statins could partly be responsible for the beneficial effects observed in patients. Earlier we reported that stimulated peripheral blood mononuclear cells (PBMCs) release homocysteine. Here we studied the influence of atorvastatin on homocysteine production in stimulated PBMCs and compared changes in cysteine concentrations and in neopterin production, which is a sensitive indicator of cellular immune activation. Stimulation of human PBMCs with the mitogens concanavalin A and phytohemagglutinin induced significant homocysteine and neopterin production compared to unstimulated cells, whereas cysteine concentrations remained unchanged. Treatment of PBMCs with increasing doses of atorvastatin (10-100 microM) suppressed both biochemical pathways in a dose-dependent manner, and cell proliferation was inhibited in parallel. Again, cysteine levels were not influenced by any treatment. The down-regulating effect of atorvastatin on homocysteine formation in vitro indicates that statins may prevent homocysteine accumulation in the blood via immunosuppression.

Relationship between homocysteine and neopterin concentrations in patients with gynecological cancer

Elevated concentrations of vascular risk factor homocysteine have been described in patients with malignant diseases, and homocysteine was supposed to be useful as tumor marker. Likewise, elevated concentrations of Th1-type immune activation marker neopterin are frequently observed in patients suffering from cancer and serve as prognostic marker for the survival of patients. In this study, the relationship between homocysteine and neopterin concentrations was examined in 18 patients with gynecological cancer. Concentrations of homocysteine and cysteine were measured by HPLC in sera of patients, folic acid and vitamin B(12) levels were determined by radioimmunoassay, and neopterin concentrations were measured by ELISA. Median homocysteine concentration was 11.2 microM (interquartile range: 9.9-13.2 microM), 3 patients had levels higher than 15 microM, the upper limit of the normal range. Neopterin concentrations were increased in 13 patients (median: 11.6; 7.7-24.9 nM), cysteine (median: 234; 216-255 microM), folate (median: 7.8; 6.2-11.7 ng/ml) and vitamin B(12) (median: 352; 258-570 pg/ml) concentrations were all within reference ranges although rather at the lower side. Higher homocysteine concentrations correlated inversely with low folate concentrations (r(s)=-0.605; P<0.01) and tended to be higher in patients with higher cysteine levels (r(s)=0.457; P<0.06; ). No correlation was found between homocysteine and immune activation marker neopterin, although the three patients with elevated homocysteine concentrations tended to have higher neopterin levels as well (P<0.07). In conclusion, only a few patients with gynecological cancer present with elevated homocysteine concentrations and hyperhomocysteinemia seems only weakly related to immune activation phenomena, tumor cell proliferation probably is more important for the increase of homocysteine.

Aspirin downregulates homocysteine formation in stimulated human peripheral blood mononuclear cells

Moderate hyperhomocysteinaemia is established as an independent risk factor for atherosclerosis, thrombosis, stroke and dementia. Hyperhomocysteinaemia is mostly caused by the deficiency of B-vitamins folate and vitamin B12, which are essential cofactors in the remethylation of homocysteine to methionine. Interestingly, moderate hyperhomocysteinaemia is also often observed in chronic diseases, in which also elevated immune activation markers such as neopterin or sTNFR-II are found. In order to simulate immune activation in vitro, human peripheral blood mononuclear cells (PBMC) were stimulated with mitogens. Stimulation significantly increased homocysteine production in comparison with unstimulated PBMC; in parallel also neopterin formation was induced. Homocysteine formation was due to cell proliferation, proliferating T lymphocytes, and also the myelomonocytic cell line U-937 produced homocysteine. Treatment with the anti-inflammatory drug aspirin dose-dependently inhibited homocysteine production and also neopterin formation in human PBMC. Treatment with salicylic acid showed similar effects as aspirin; FACS analysis showed that both compounds inhibited cell proliferation by arresting cells in the G0/G1-phase. In U-937, both compounds also slightly induced apoptosis at 5 mm. Proliferation-induced homocysteine formation and in parallel also monocyte activation can be suppressed effectively by aspirin and salicylic acid in vitro, suggesting that also in vivo aspirin may downregulate not only inflammation but also formation of homocysteine.